【作者】 魏静；

【导师】 陈兵；

【作者基本信息】 第三军医大学 ， 内分泌与代谢病， 2010， 硕士

【摘要】 研究背景垂体肿瘤手术及放疗是引起成人生长激素缺乏的重要原因之一.成人生长激素缺乏会引起肌肉质量减少、肌力下降,内分泌和脂质代谢异常以及心血管事件增加,生活质量下降。国外有研究表明垂体瘤手术摘除肿瘤以后,自身生长激素多分泌不足,无法维持正常生理功能。而在国内,医师对垂体瘤术后患者的肾上腺激素、甲状腺激素、性腺激素水平关注较多,且能尽快补充,但对此类患者是否存在生长激素缺乏,以及缺乏水平、临床特点及激素补充治疗却鲜见报道。研究目的研究垂体无功能腺瘤术后患者生长激素水平及是否缺乏,总结缺乏患者的临床特点,量化考察其生活质量及心理状态,为后期验证成人生长激素缺乏症患者应用生长激素的有效性及安全性提供理论基础。研究方法对我院门诊就诊垂体无功能腺瘤术后并符合初选标准的31例患者进行临床研究。对所有患者均行ITT试验,隔夜晚10点开始禁食,试验前6h开始禁水,清晨空腹平卧行药物激发试验:晨9时胰岛素静脉推注,起始剂量按0.10～0.15U/Kg给药,分别于注射前30分钟,注射后0分钟、30分钟、45分钟、60分钟、90分钟、120分钟测指尖血糖,并同时于各时间点取血2ml测静脉葡萄糖,取3-5ml送往检验科测生长激素水平,共测7次静脉葡萄糖及GH,试验过程中注意观察低血糖等不良反应,积极对症;对经ITT试验确诊为GHD的患者,纳入后续的实验组(GHD组),另设健康者(NC组)作为对照组,同时行ITT试验对照;实验组(GHD组)及健康对照组(NC组)均行内分泌激素(甲状腺激素、性腺激素、肾上腺激素)及血常规、肝肾功、血脂、OGTT的检测及身高、体重、体重指数(BMI)、腰/臀比(WHR)、体脂率(FAT%)、腹部皮褶厚度、左右手握力等测量;并用成人生长激素缺乏症生活质量量表(QoL-AGHDA)及焦虑评分量表(SDS)、抑郁评分量表(SAS)评估对两组患者的生活质量及心理状态进行评估。研究结果1)共31例患者符合初选条件,均顺利完成ITT试验。均于注射胰岛素30-45分钟间出现低血糖反应,且血浆葡萄糖最低水平≤2.2mmol/L或≤基础值的50%,为有效激发。其中29例患者(93.5%)表现为生长激素缺乏,23例患者GH峰值水平<=3μg/L,且曲线呈低平状态,表现为GH严重缺乏,2例GH峰值水平>5μg/L.表现为生长激素储备功能正常。2) GH严重缺乏组峰值点多集中出现于30分—60分之间,而相对缺乏组多集中于45-60分之间,且严重缺乏组患者生长激素激发后GH呈低平状。3)GHD组患者常表现为体力减低、食欲下降、睡眠质量差、性欲及记忆力低下。4)GHD组患者体脂率(FAT%)较NC组显著增高(27.082±6.20 VS 23.43±3.76,P=0.009);皮下脂肪厚度较正常对照组有增高趋势(31.04±8.44 VS 29.55±8.32),但无统计学差异;腰/臀比高于正常对照组(0.86±0.053 VS 0.83±0.76 P<0.05)5) GHD组甘油三酯较正常对照组显著增高(3.46±2.28 VS 1.07±0.37 P<0.01),血总胆固醇较正常组有升高趋势,但无统计学差异,高密度脂蛋白较正常组有下降趋势,亦无统计学差异。6)GHD组与相应的性别、左右手的对照组比较,握力均显著低于正常对照组(P<0.05)。7) GHD组QOL-AGHDA评分较NC组显著增高(7.96±3.35 VS4.57±2.22 P<0.05)。两两比较中,严重缺乏组评分显著高于NC组(P<0.05),相对缺乏组与NC组比较评分增高,但无统计学意义。8)GHD组患者焦虑20例,占68.9%。对照组焦虑12例,占31.5%。生长激素缺乏组焦虑评分明显高于对照组,二者有显著性差异( P< 0.05)。8)生长激素缺乏组患者抑郁13例,占44.82%;对照组抑郁9例,占25.7%;生长激素缺乏组抑郁评分较对照组有升高趋势,但二者无统计学差异( P>0.05)。研究结论1、垂体无功能腺瘤患者术后多存在严重生长激缺乏,应加以重视并监测;2、垂体无功能腺瘤术后GHD患者,常表现为体力减低、食欲下降、睡眠质量差、性欲及记忆力低下,存在体脂率显著提高、血甘油三酯显著增高、握力显著下降等身体组分、脂质代谢、肌体活动能力下降的一系列病理生理改变;3、此类患者QOL-AGHDA评分显著增高,生活质量明显下降,并存在焦虑及抑郁情绪,应尽早发现,给以干预措施,提高生活质量。更多还原

【Abstract】 Background Pituitary tumor surgery and radiotherapy is the one most important reason of adult growth hormone(GH) deficiency(AGHD) . AGHD often cause muscle quality reduce, strength decline, endocrine and lipid metabolic abnormal, cardiovascular events increase and the quality of life decline , while cause psychological problem. Research abroad show that the GH of the postoperative pituitary patients tumor insufficient , can not maintain the patient’s normal physiological function. In domestic, physicians pay more attention on the hormones (adrenal hormones, thyroid hormone,gonad hormone) level of the postoperative pituitary adenoma patients,however less attention on weather growth-hormone deficiency,and the level of growth hormone, clinical characteristics and hormone supplementary treatment .Objective to test the GH-hormone of the nonfunctional pituitary postoperative patients and summarize clinical characteristics, investigate quality of life and psychological state, and providing theoretical basis for GH applicating in adult growth hormone deficiency patients.Methods patients were in line with 0riginal Selection Standard in the outpatients of our hospital Twenty-nine patients were selected into trials group (GHD–group) by insulin tolerance test. The people who were healthy volunteers were selected into normal control group(NC-group). All the people were performed the drug probocation test,Insulin was intravenous injected with 0.10-0.15U/Kg,detected the fingertip capillary blood glucose levers at -30minuts before injection and 0、30、45、60、90minuts after injection,at the same time , their levers of growth hormone(GH) and blood glucose were also detected at -30、0、30、45、60、90、120 minuts,kept observing the reactions during the whole test.The people who were healthy volunteers were selected into normal control group(NC-group).The two group were tested by endocrine hormone examination(tetraiodothyronine、hebin、adrenal hormone)、blood routine examination、liver, renal function、blood lipid、OGTT (oral glucose tolerance test)、body height and weight、body mass index (BMI)、waist hip ratio (WHR)、FAT%、skin thickness、left and right hands grip strength.We evaluate the quality of life and the mental state by the analysis of Quality of Life Scale (QOL-AGHDA ,Holmes et al, 1995), Zung Self-Rating Anxiety Scale (SAS) and Zung self-rating depression scale (SDS) .Results: 1、All the patients(thirty-one) in line with the primary selection standards finished the examination of ITT smoothly. They show hypoglycemic reaction and the lowest level of Glucose ,which was lower than 2.2mmol/L or lower than 50% of basic level. ,it indicated the test was effective. Twenty-nine patients show the GH deficiency, twenty-three patents show that the GH peak level was lower than 3μg/L, and the GH curves was in low and flat condition, which show the severe shortage of GH. Two patients whose GH peak levels were higher than 5μg/L show normal.2、The peak points in severe GH shortage group focus on the level between 30 to 60 minute, and the relative GH shortage group focus on the level between 45 to 60 minute .The GH level of patients in severe GH shortage group was in lower state .3、The patients in GHD group show decreased in weight、appetite、the Quality of sleep、libido and anamnesis which show no specificity.4、FAT% in GHD group increased significantly(27.082±6.20 VS 23.43±3.76,P=0.009)and the thickness of subcutaneous Fat was higher slightly than NC group(31.04±8.44 VS 29.55±8.32)which show no statistical difference. WHR in GHD group was higer than NC group (0.86±0.053 VS 0.83±0.76 P<0.05).5、Triglyceride in GHD group increased significantly than NC group. (3.46±2.28 VS 1.07±0.37 P<0.01).Blood total cholesterol was higher slightly than NC group which show no statistical difference. High density lipoprotein was lower slightly than NC group which show no statistical difference.6、The hand grip strengths in GHD group were lower than NC group Comparing with Corresponding gender and hands.(P<0.05).7、Scores of QOL-AGHDA in GHD group were higher significantly than NC group(7.96±3.35 VS4.57±2.22 )and show statistical difference. The scores in group which the Growth Hormone is in severe shortage increased significantly than NC group(P<0.05) and the scores in relative shortage group increased slightly which show no statistical difference.8、There were twenty patients in anxiety state who take 20% parts in GHD group ,and 12 who was 31.5% in NC group .the scores in GHD group were higher significantly than NC group and show statistical difference ( P< 0.05).9、there were thirteen patients in depression who take 44.82% parts in GHD group and nine who was 25.7% in NC group .the scores in GHD group were higher than NC group but show no statistical difference( P>0.05).Conclusions: 1、Most of non-functioning pituitary adenoma postoperative patients are in severe shortage of Growth Hormone and should be paid more attention and monitored. 2、clinical symptoms of non-functioning pituitary adenoma patients after operation are no specificient. There are some characteristic Pathophysiological changes ,such as the FAT% and Triglyceride increase, the Lipid Metabolism and the body activity ability decrease . 3、The scores of QOL-AGHDA in non-functioning pituitary adenoma patients after operation are higher ,and the quality of life decreased severely .these patients are often afflicted by Anxiety and depression ,shoud be detected and treated earierly to promote the life quality..更多还原